Social workers’ values influence assessment outcomes more than eligibility thresholds

Councils should focus on improving the consistency of social work assessments instead of cutting staff to make savings, according to a report from the Institute of Public Care.

The report found reductions in social work numbers could increase the cost of care packages. It said the values and risk thresholds of practitioners were most likely to determine service user outcomes and the associated costs. It also pointed to previous research showing a link between high investment in assessment and care management staff and lower numbers of admissions to residential care.

Instead of cutting frontline assessment and care management staff, councils should focus on achieving consistent social work practice to ensure service users don’t receive higher care packages than necessary to meet their needs, the report said.

‘Risk averse practice’

The report was written by John Bolton, visiting professor at the Institute for Public Care. It is based on Bolton’s direct work with councils over the last five years; findings from the Local Government Association’s adult social care efficiency programme; and a piece of work commissioned by the Department of Health with six councils during the 2015 spending review.

Bolton told Community Care there was a significant variation in social work practice, both between councils and within them.

“There are many creative social workers finding creative solutions but there is also a large cohort of social workers who tend to be quite risk averse in their practice,” he said.

“I don’t blame them because it is absolutely clear to me that the number of social workers have been cut, but these are the social workers who tend to create the higher cost care packages.

“Councils need to be aware of that and of the fact that the mechanisms they have, such as stating public eligibility criteria or having assessment panels, won’t work unless they are absolutely clear with staff about what they want from their practice.”

Bolton added that many councils were using asset-based social work or ‘promoting independence’ care models to build new relationships with service users. Both seek to draw on an individual’s strengths, skills and existing support networks to help maintain their independence, which can in turn reduce the need for formal care services.

However, Bolton said financial constraints meant some local authorities felt the only solution was to “assess people in crisis, meet their needs and that’s it”.

‘Risk of judicial review’

The report found there was little scope to save money through competitive tendering or squeezing the prices paid to care providers. However, it said there was “still some room” for councils to externalise in-house provision and negotiate care costs for adults with severe learning disabilities and those with mental health needs, in order to make savings.

There was also little scope for further reductions to personal budgets and direct payments, because councils would risk judicial review if they did not offer sufficient funding to meet the assessed needs of service users, the report said.

This finding echoes concerns raised by a recent report from the National Audit Office, which looked at personalised commissioning in adult social care.

Bolton said: “All the previous evidence is that direct payments should not be cheaper or more expensive than ordinary services. But we certainly found that some councils are being very stringent in how they get their resource allocation systems to work and are trying to share less money between the people who are going to get it. There are risks in that of course.”

‘Still scope for savings’

The report concluded that there was still scope for some councils to refine their model of social care and ensure individuals were offered the ‘maximum opportunities’ for recovery.

The use of reablement, recovery and rehabilitation services at the point of hospital discharge was highlighted as one of the most effective examples. “The help and range of interventions that are offered to an older person at the point of their discharge will make a big difference to the longer-term outcomes for them and their likely need for more or less care,” the report said.

Bolton added: “I still think there are places where councils can save money, but this is a bloody tough time for some councils and places I’ve visited, such as Tameside and North Tyneside, have taken 20% out of their budget in real terms. It’s really hard for these councils, for the social workers and managers, to sustain a really good model of social care, to keep the welfare of their citizens at the heart and manage within their budgets.”